We are arguably living in a golden age of medical science. The great infectious scourges of history — smallpox, diphtheria, polio — have been nearly vanquished by vaccines. Previously deadly infections like appendicitis can be cured with surgery. Cancer and heart disease are yielding their secrets and conditions once thought to be due to sorcery or divine will — from epilepsy to infertility — are now understood and treated. Yet a large swathe of the American population is gullible enough to believe in and spend their money on quackery.

Who believes in quackery and why?

Believers in quackery are easy marks for unscrupulous marketing messages that are tailored to appeal to their egos for the purpose of draining their wallets.

From patent medications and nostrums to super-foods and miracle supplements, medical fraud, often referred to as “quackery,” has historically been a pressing and emotionally charged issue for health care professionals. Much like today, historical analysis of 18th century English quackery shows that those making dubious medical claims excelled at 3 things: taking advantage of new market opportunities, building a brand name, and advertising their product.

Who is susceptible to being tricked by quackery?

Overall, the typical CAM [complementary and alternative medicine] user tends to be female, middle aged, and college-educated, with lower perceived health and a higher level of spirituality (seeking answers and understanding to ultimate questions regarding life and its meaning and relationship with the sacred)…

The authors explain that the typical quack marketing plan is based on four straw-man metaphors:

Profit-mongering “Big Pharma”
The doctor as a deity
Illness as war
The body as a machine

They offer one of the best explications of quack philosophy that I have read.

The metaphors used by alternative medicine amplify genuine critiques of the medical community to extremes, attacking the ethos of modern medicine and its practitioners while moralizing the healing process and dichotomizing medical treatment. In this dichotomy, modern medicine is a cold, disjointed, toxic, “evil” and unnatural force of technology in contrast to a more natural, holistic, pure, good, and balance-driven force for unity that seeks to create conditions of health instead of merely treating specific pathologies. Through all of these arguments, alternative medicine relies on the pathos of anecdotal evidence to prove its efficacy, reinforcing to patients that they know their body better than any medical professional and that they should be treated as an individual and as an equal in the healing process.

To a large extent, as I’ve written in the past, doubt is the primary product of all quacks, specifically doubt about modern medicine and doubt about physicians.

Doubt about modern medicine:

Anything not seen as natural, from vaccines to antibiotics, is Big Pharma’s attempt to accumulate wealth at the expense of the unsuspecting public. Thus, the alternative medicine movement undermines the ethos of Western medicine and establishes a distrust of “unnatural” treatments. Health care has been compared to a “medical market,” where all practitioners “bid” for the trust of their patients. This establishes an ethos attack that sets up modern medicine as a conniving profit center, with the friendlier, seemingly straightforward, natural approach of alternative medicine standing in stark contrast.

Doubt about physicians:

In the “doctor as god” metaphor, alternative medicine … create[s] a perception that Western medical professionals think they know more about their patient’s body and how to heal it than the patient does… This is especially designed to rub against the beliefs of an educated, spiritual audience accustomed to seeking the answers to their own questions, and making educated decisions based on those answers. Once this straw-man has been set up, alternative medicine is able to offer a more egalitarian relationship between a patient and practitioner, emphasizing that a patient knows their own body far better than any physician, and therefore is an integral part of the healing decision process…

The authors also address the other two strawman arguments.

Illness as war:

…[I]llness is the enemy, and practitioners are soldiers fighting for the victim. While this metaphor has been used by modern health care, CAM proponents amplify the metaphor, and then attack that amplification. Alternative medicine proponents … caution that medications, like weapons, can be dangerous and backfire on the user, causing harm or provoking more aggressive tactics from the “enemy.” Then, they offer an alternative by stating that pain is not something to fight, but a messenger and a gift offering a clue to what is wrong in the patient’s life, illuminating behaviors and lifestyle habits that produce negative effects for the patient. The patient subsequently works with their health care practitioner to address their entire life from that gift of pain…

Body as machine:

…[Proponents of] alternative medicine … argu[e] that modern medicine views the patient as a machine to be fixed, just as a mechanic may repair a car. They claim that medical treatment relies on technology to treat separate parts of the body that can be detected as broken. Modern medicine, in this straw-man metaphor, attempts to control or quantify every variable, leading to over medicalization and overtreatment… In response to what they view as a brushing aside of the role of mind, emotions, and the entire person in health, alternative medicine argues that the body and spirit must be viewed as a whole, as a part of a wider balance process…

The authors offer a chart that lists the characteristics of typical believers in quackery and how the marketing messages are crafted to appeal specifically to those characteristics:

How can doctors, scientists and public health officials counteract the marketing talents of quacks?

Those who use alternative medicine may be more susceptible to its lure because the rhetoric of these movements appears to be targeted at them. Quackery especially relies heavily on pathos arguments for persuasion while undermining the ethos of modern medicine, appealing to the desire for independent thought process in the spiritually minded, more highly educated demographic. This sets up a moral dichotomy in medicine, where modern medicine is seen as cold, artificial, toxic, and disconnected in comparison to the more personable, natural, pure, and holistic approach of alternative medicine that empowers a patient to be a part of their own healing. Knowing this rhetoric, Western medical practitioners should adjust their interactions with patients to educate, inform, and empower their own patients to be able to make lifestyle changes as well as providing medication therapy.

As I have written in a wide variety of contexts in the past, quackery is a big business promoted by those with extraordinary marketing acumen. Believers in quackery who pride themselves on being resistant to the marketing messages of the business that is medicine should be alerted to the fact that they are easy marks for the unscrupulous marketing messages of the business that quackery, messages that are tailored to appeal to their egos for the purpose of draining their wallets.

In regards to depicting quackery, throw in some pharmacudicala in the picture there are plenty quakers that are sold to us as scientific treatment.

Steph858

How DARE you compare modern alternative medicine with old-timey patent medicines and nostrums?! Why, you oughta be sued for libel!

… by the Nostrum sellers, that is. Back in the good ol’ days, patent medicine was full of alcohol, opiates and cocaine. They might not have cured what ailed you, but they would certainly have made you feel much better – at least for a while.

By contrast, these Millennial Charlatans’ tonics usually have no effect whatsoever. If a patient is lucky enough to stumble upon a semi-competent herbalist, the treatment they receive MIGHT have some discernible effect. Alas, all the good plants are now illegal so there’s no chance of today’s patent medicine containing a comforting dose of poppy juice. At best, you’ll get an allopathic precursor of unknown purity and strength (a hunk of willow bark or a bunch of foxgloves, for example).

The Bofa on the Sofa

Fun fact: A “gin and tonic” was invented because the tonic water used to treat malaria (quinine) was so nasty and bitter that they mixed it with gin to make it more palatable (a “spoonful of sugar” as it were). It turned out to be a good combination, and caught on.

Gene

Heh, I used to drink tonic water as a kid. I LIKED it! I still drink it on occasion. But I hate gin and tonics. It tastes sour and nasty to me.

Roadstergal

I like tonic water, and I love a gin and tonic. I think that makes me a ’50s housewife.

kfunk937

Adding my G&T endorsement, as well as tonic water alone. My family makes a “virgin mimosa” with OJ and tonic, fancied up with maraschino juice for kids, that’s popular.

Beware blackwater fever, then. Although if affected, and a ’50s housewife, I s’pose mebbe the barbituates would exert a protective effect. 😉

I’ve heard that legend before and thought it sounded like a feeble excuse to drink on the job. “No, boss, adding sugar to my tonic won’t make it palatable in the least! The only thing which will do the job is gin, at a ratio of no less than 1 part gin to 2 parts tonic mind.”

Mariana

Just out of curiosity, can tonic water produced today and sold as soft drink still be used to treat malaria? How does (or did) it work?

I do love tonic water, gin or no gin. It’s the only soda I really crave.

It’s got enough in it to kill my relative, who has G6PD deficiency and is missing an enzyme that allows quinine to be processed. He can’t eat a bunch of foods nor take any sulfa drugs or he risks pissing out his red blood cells.

The poppy seeds you bake with are potent enough to kill you if you make a tea with them.

Steph858

Cannabis seeds are also legal (at least in the UK). They only become illegal once seed touches soil (or artificial simulation thereof). In theory one could be subject to a police raid which uncovers one’s little farming project, but in practice unless you’re too incompetent to disguise the heat and electrical use generated by the lamps or too stupid to keep your grow room’s ventilation fan a reasonable distance from passersby’s nostrils, the chances of getting caught are pretty slim.

Of course, the odds of being caught increase exponentially once one leaves the safety of the primary sector for the profitability of the tertiary sector. Growing a few poppies probably won’t result in any trouble from the cops; selling the juice from those poppies (whether on its own or in some patent tonic) very well might.

Christopher Hickie

A veritable army of quack physicians now continuously stokes the fires of quackery, doing so with little risk to their professional reputation or medical license. Therein lies a big part of the problem.

Until some of these quack docs are sanctioned by medical boards and medical societies, too many well-meaning people will follow these quacks. You have the fortitude to go after them, Dr. Tuteur. So does Dr. Jen Gunter. But then when the quack Drs Gundry and Romm attack back (as in this recent jade egg issue)–well that would be a good time for a group of doctors (like ACOG) to step in and mop the floor with Gundry and Romm–by having a news release/press conference denouncing them as quacks. And then publicly ACOG should report those two bozos to their state medical boards for promoting something as moronic and dangerous of jade eggs in vaginas–which truly is medical incompetence. Even if the state medical board did nothing (as always happens), mass public shaming of quack doctors by medical colleges/academies/societies would send a very strong message to the public about these bozos (which sadly has not happened regarding anti-vaccination either as there are anti-vaccine members of the AAP that the AAP refuses to discipline or expel despite calls over this last decade to do so).

And, somehow this hands-off policy of medical boards against what quack doctors publicly say has to stop. When a physician gives quack advice as a physician (meaning they use their MD/DO status to better convince their audience), that speech should not be protected under the 1st Amendment (e.g. http://www.phoenixnewtimes.com/news/arizona-anti-vaccine-doctor-to-keep-his-license-medical-board-rules-7511301 ). There are well defined standards of care in many areas of medicine, and when a physicians decides publicly to go rogue against those standards by publicly promoting dangerous alternate care, well, there should be repercussions based on state laws regarding medical incompetence.

Medecine has always been “magic”, and, even now there are practitioners (fewer than formerly, thankfully) who try to keep it mysterious and guard its secrets. For a very long time, doctors retained the use of Latin for no other reason (especially when they didn’t want the patient to know how ignorant they themselves were). So why it should seem so surprising that just about anyone can come along and spout some jargon which sounds medical or scientific and be regarded by a certain part of the population as “knowledgeable” or even “expert”? Take the simple term “abortion”. To the lay mind this means an induced termination of pregnancy; to any medical person it has a mch wider range of meaning. Try explaining to a lay person what DIC or HELLP Syndrome is. It means as much as telling the average joe that he has a terminal case of Dunning-Kruger Effect.

Two further points: it’s been shown that, compared to the average standard allopathic consultation, “alternative” (quack) practitioners spend a longer time with patients, and are often more “hands-on”, and less engaged with their computer screens. This gives the patient the impression of greater caring, ergo, better care. It has also been shown that as many as 80% of ER patients don’t understand their discharge instructions. There are several reasons for this (being in pain or mild shock) but a lot of it is that the instructor, usually in the first instance, is a doctor who does not speak in terms the patient understands, but in medicalese. Thousands of times I’ve been asked, after the doctor has left the room, “what did he say?” To the quack, however, everything is simple, and he so assures the patient, which is comforting.

Empress of the Iguana People

may your flowers always be shiny and bright

Eater of Worlds

That’s supposedly one reason why women are turning to these quacks. They feel their needs aren’t being met by regular doctors and the caring these quacks provide means to them that their options are better.

It’s also how acupuncture works. The nicer and more involved the practitioner, the better your results. You don’t even have to touch the person to get good acupuncture results (good for acupuncture, that is, not good overall). Just having a nice sympathetic person talking to you about releasing your pain/illness/aligning your chai with your coaster gets the results.

Sue

Interesting expose’ of the “wellness” industry in this radio broadcast, and the associated book:

Not only does it appear to be human nature to seek simple, directed solution, but we also seek patterns in life, so we make associations and assume causation when the two events might be coincidental.

It’s this last tendency that most “wellness” therapies trade on, as well as the placebo effect.

Sheven

There are shades of the diet industry or the pyramid scheme or other aspirational cons in quackery as well.

If you don’t lose tons of weight when you diet, the problem isn’t the fault of the diet guru who tells you to eat 1400 calories a day while exercising four hours, it’s your fault for not having discipline. These specially-picked people have managed to do it!

If you don’t make money selling vitamins or hair products, the problem isn’t the fault of the people who expect you to make a living selling shampoo to your friends, it’s your fault for not being motivated enough or not positive enough. These specially-picked people have managed to do it!

And if you don’t feel better by grinding your own flour and wearing all-natural fibers, it’s not the problem of the people who told you that eating more legumes and drinking water with lemon every morning would make you thinner, and smarter, and fill you with energy, and stop your kids from being autistic, and cure your lupus. It’s your fault for eating that hamburger once. Or maybe for cleaning your oven with something besides white vinegar salt scrub. Or maybe for hanging on to that part-polyester t-shirt. Or for not shoving a jade egg in your vagina. Or for not “detoxing” often enough. These people can do it!

Young CC Prof

Giving near-impossible “homework” is an important part of the quack business model. If the patient improves, the treatment gets the credit, but if the patient fails to improve, it can always be blamed on patient noncompliance, because the regimen is so complicated that no one follows it perfectly.

To me, there seems to be a superficial link between health professionals attitudes and training, and how they are perceived by patients. Medical care has become increasingly patient-led: I graduated 30+ years ago, and even back then there as a distinct push towards less paternalistic care, more patient-doctor partnership, shared decision-making, full disclosure of risks and benefits. But as this has become more and more embedded in current healthcare practices, alternative medical practitioners and practices have flourished.

My impression is that these practitioners seem to have no issue about saying ‘You MUST do this, you MUST take that, you MUST do what I say’; they seem to be far more paternalistic than any doctor I’ve ever worked with. Does this mean that some patients are more comfortable with a more paternalistic practice? That they want to go back to being told ‘I know what’s best for you, do what I say’? I honestly don’t know. But I know that the current model of conventional health care is to be open and honest and if we don’t know, or can’t say, and can’t predict outcomes etc, then we discuss that with the patient. Alternative practitioners generally don’t (except in very tiny small print on their websites where they say that that they refuse to take any responsibility for the information on their site), so do some patients actually prefer to be infantilised like that? Or is this ‘authoritative’ paternalistic model a placebo effect which is why CAM seems to work for some people?

Sheven

“But *I’m* not doing anything. *I* am just setting out the simple, natural guidelines that *you* know in your heart are best for you. You and your body are what will heal your condition. The only sad thing is that the rest of society, those dummies, don’t know what you know, can’t educate themselves (through my teachings) like you can, and don’t have the strength to resist that you do.”

fiftyfifty1

It seems to me that CAM switches between egalitarianism and paternalism to suit the situation. The first half of the visit is all about “you’re the expert on your own body” and the second half is “do these certain things I say and buy these certain supplements I sell, and all is certain to be well.”

Sue

^^^^^ THIS!

“Alternative” providers are what I call the New Paternalists – rising up as medical paternalism has been falling.

It’s post-modern paternalism – where you can feel that you are sticking it to “The Man”, the Medico-Industrial Complex and Ebil Gummint while simultaneously unquestioningly following the simple, directed advice of some “guru”.

We seem to be attracted to simple, directed advice, but our current culture likes it disguised as “freedom of choice” and with a touch of rebellion.

Especially the one about the “two responses to pertinent questions.” Good grief! I have never received anything like that, the usual reaction is something along the lines of excitement followed by “Oh! You’re a nurse/doctor/etc.” (and the awkwardness of explaining that I counter anxiety by learning) or visible relief and “You read up on this? Good!”

Kerlyssa

see that w doctors who are lyme literate, or willing to give out w/e bullshit treatment. the way their patients talk about them…

look, i like my gp, and am fairly confident in her skills(i mean, it’s not like i am an expert). if someone needed a pcp, i’d recommend her. but i do NOT talk about her like she is in control of my life. people’s comments sometimes remind me more of talking about a sub/dom relationship than a doctor/patient one. and, yeah, if you view doctor shopping as picking your dom, and hospital visits as scene negotiations… a few more things make sense 🙁

//not actually saying this is people’s kink, just saying the social dynamic seems similar

Like Yolanda Foster, she fell under the thumb of the Lymiest Lyme quack on earth. It’s like these people belong to a cult, if you read their posts about getting treatment and what they do they all sound programmed. It’s scary what these groups are doing to them and sad that these people felt so sick that they latched onto this of all things to help them feel better. https://sciencebasedmedicine.org/does-everybody-have-chronic-lyme-disease-does-anyone/

Dr Kitty

There are a subset of patients who come to me with obvious issue X.
I diagnose it and tell them that the options are A, B and C with the chances of working and side effects and so on, and that they can tell me what they’d like to do.

Then they ask me if I’m sure there isn’t a 100% effective, side effect free treatment option (nope, there never is, and even if there was I’d already have mentioned it).

Then they say “oh, well, I’m not really a tablet person anyway, I’ll just see if it gets better on it’s own, or try something more natural”. This is usually after they have come to me as a last resort having already had symptoms for a long time and tried time and placebos already.

At which point I wonder why on earth they came to see me at all…

Apparently unless Western medicine is 100% risk free and 100% effective it’s useless, but some herbal thing with vague claims of effectiveness that costs a fortune and might fry your liver is worth trying.

I do feel like they’re playing a scene and I haven’t got the right script sometimes.

mabelcruet

You said it far more eloquently than I!

As a pathologist, one of my biggest worries is consent. The vast majority of my autopsies are done with maternal consent (the way the law is, for babies born dead-miscarried or stillborn, maternal consent is required, for babies who die after delivery, either maternal or paternal consent is required, but generally we like to have both). Prior to the organ retention issue, the consent forms were quite straightforward and didn’t really go into a lot of detail about the procedure. When the new Human Tissue Act came into force, the consent forms got far more complex. The parents have to make a decision on the type of examination (full, partial, limited), whether we can do genetic testing or not, whether we can keep whole organs or not, how they want us to dispose of any organs that we retain, what uses we can put retained tissues to and so on.

I get more complaints about the consent forms now-for parents immediately bereaved, what we are having to do is say ‘it would be helpful if we could keep your baby’s brain for further testing, it’ll be stored in the mortuary, once we’ve looked at it, how would you like it back?’. It’s so grim-I’ve had quite a few parents say to me ‘can’t you just do what you think best?’, but I can’t, it wouldn’t be legal. It’s a complex, convoluted and detailed form with a lot of specific areas to consider, and for parents who have just lost their baby, I’ve no doubt that they aren’t really able to process it all. Sometimes, paternalism might be a little gentler I think.

Being a partner in medical decision making can be scary as a patient. In a paternalistic model, the “blame” for a treatment not working can be placed entirely on the doctor or the treatment by the patient. It’s not that cut and dry in a shared decision-making model.

Plus, there are occasionally moments when shared decision-making goes awry. My son had a check-up with a physician’s assistant two days after he left the NICU. The PA was not my favorite, but the check-up was doing fine(ish) until she looked at me about 5 minutes in and asked me if he’s supposed to be developmentally at 4 months (his calendar age) or at 2 weeks (his adjusted age). I said “Two weeks. He didn’t jump to 40 weeks development when he was born.” There’s a moment of awkward silence then we start discussing follow-up appointments. She looks at me and says “How often do you think we should follow up with him?” I look at her as if she’s bat-shit crazy and reply, “You tell me. I’m a teacher, not a medical professional and this is my first kid.”

J.B.

There’s a lot that we as patients don’t know, and asking questions in the right way is important. Like side effects of aggressive treatment and monitoring.

Spawn started having issues with reflux a bit after that. The scariest problem was that he would have severe choking episodes where he couldn’t clear liquid from his pharynx without having us flipping him upside down and pounding on his back as his 02 readings tanked to below 60%.

In the last series of phone conversations I had with her, we worked our way through her best solutions:
1) Adding solids to his diet since he’s nearly 5 months (calendar age)
Me: Hell, no. He’s still tongue-thrusting as 3 week olds generally do. Plus, a thin liquid like formula is relatively easy to clear when he chokes. Bits of pureed food or grain take a lot longer and make for far worse aspiration pneumonia.

2) Maybe you inserted his NG tube into his trachea and that’s where it is now causing the choking.
Me: My husband did insert the NG tube into his trachea once. Spawn acted exactly like the nurses told us he would: he visibly panicked, turned colors and began to thrash since we were cutting his air supply off within seconds of starting to insert the tube. He whipped it out of Spawn’s nose and Spawn started screaming. Best sound in the world.

3) Maybe he doesn’t need a NG tube anymore.
Me: I’d love that, but he’s drinking about 30% of his feeds by mouth and falling deeply asleep from exhaustion after that. He’s not going to do well on 1/3 of the calories he needs to survive.

4) I really don’t know much about preemies / kids on NG tubes / kids on oxygen. What do you think we should do?
Me: Is there someone in your practice who does know about preemies/NG tubes/oxygen? (Yes.) Have you talked to them? (No.) You are going to need to talk to them before you call me again. (That’s a good idea.) Have you talked to Spawn’s primary doctor at your practice? (No, because she’s not had an appointment with him.) She doesn’t know any of this? (No.) You NEED to update her on this. Now. (That’s a good idea.)

That’s when I called the practice and requested two things:
1) Have Spawn’s primary take over his care now. Sign us up for a same-day appointment or whatever if she needs to see him physically first, but get his D.O. on board.
2) Remove that PA from his care. She and I do not work well together; I’ll happily see any of the other PA’s or the FNPs.

EbbyBee

Oof that’s awful. Originally I wanted my girls to see our family doctor but when they were very premature we decided to go with one of the larger pediatric practices in the area because I wanted someone with extensive experience with preemies. Those are not things that you want to hear from your child’s care provider.

Young CC Prof

Yeah, it definitely sounds like that PA is not the right provider for a recently released micropreemie with complex health needs. Would have been good if she had been the one to say this, rather than floundering.

Empress of the Iguana People

I had a student teacher mentor like this. He wanted *me* to tell him what *he* was supposed to be doing. Um, I know I’m your first mentee, but dude, I gave you a giant packet of papers. Since it was for you, I didn’t read it. And that’s just for lowest level of student teaching (mostly observation, teach one class), no one was damaged by my errors.

mabelcruet

Are you all sorted now? That sounds like a nightmare to navigate through.

Oh, yes. His primary took him over right then. She’s known me and my family for years and called to let me know that she’d prefer to not potentially expose him to any more germs than was needed.

We also had a speech-and-language pathologist who got us a much earlier appointment with a neurodevelopmental pediatrician who is highly experienced in dealing with more complicated little ones. She’s acting as the first line of contact for anything involving medical equipment (like that time he developed a random rash under his chest electrodes that cleared up on its own) and his occasional reflux issues.

His family doc primary covers the more average baby issues like immunizations and well-baby checks plus any routine monitoring like his electrolyte blood work and weight checks.

mabelcruet

Hmmm…not the way inspire confidence really. I know Spawn was really very premie, but you’d think she would have handled other prem babies and knew what the protocol was and how to calculate adjusted ages.

namaste863

I love modern medicine. I love the fact that I can take a little shot, and not have to worry anymore about contracting some sort of disgusting disease. I love that if I do get sick, I can take an antibiotic and feel better in a few days. And if I never see another kale salad again, it will be too soon.

swbarnes2

But on the other hand, I think that has gotten some people to think that medicine can fix everything. So if they find a doctor who says “Sorry, I can’t fix your back pain”, they assume there must be a doctor who can. And then they find a quack who says they can.

The quacks also tend to make the patients feel like they are in control: “You can fix all your problems with behavior changes and supplements” where as doctors have to say “This medicine might or might not work, you can’t do anything but take it and wait and see”. The former stance appeals to those who fall for the Just World fallacy.

The Bofa on the Sofa

Or, more simply, quacks lie. I have pointed this out before. Doctors will be honest, and honesty is not always reassuring. Meanwhile, quacks lie all over the place.

I noted this many years ago with Suzanne Sommers’s book about cancer “cures.” Her selling line was that, regular doctors won’t tell you they can cure you. The people in her book however, will.

I’m like, yeah, that’s true. That’s why they are quacks! Jesus Merlin Christ, not only are doctors hesitant to call something a cure, they spend time wrangling about what “cure” even means in this case. Quacks, otoh, spray it around meaninglessly.

You damn right that is the difference between legitimate doctors and those in her book.

Sue

“honesty is not always reassuring”

I’ve been grappling with this fact in my own practice (in Emergency Medicine) – how to be honest while still validating the patient’s needs and providing what they need to feel reassured.

My current model includes explaining what is going on – the pathophysiology of a symptom or a condition. Medical training involves learning how the body works, in health and diseases, at a profoundly detailed level. Where possible, assessment and diagnosis should involve an understanding of what is happening at both a macro (anatomical) and micro (tissue, cell, and sub-cellular, biochemical) level.

So, my current approach is to validate symptoms, explain “this is what is going on that produces those symptoms, and this is what we know works or doesn’t work, and this is the natural course of the issue.”

This explanatory/educational approach can take time, but it saves me heaps of time in tests and treatments that are not needed.

Then, some of it includes being authoritative and confident too – which I’m better at as I get older. Not the false confidence of the shyster, but the quiet confidence of being capable at the job you are trained and experienced in – like any skilled person.

Amy Tuteur, MD

Dr. Amy Tuteur is an obstetrician gynecologist. She received her undergraduate degree from Harvard College in 1979 and her medical degree from Boston University School of Medicine in 1984. Dr. Tuteur is a former clinical instructor at Harvard Medical School. She left the practice of medicine to raise her four children. Her book, Push Back: Guilt in the Age of Natural Parenting (HarperCollins) was published in 2016. She can be reached at DrAmy5 at aol dot com...
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